Background: Acute ischemic stroke (AIS) with large vessel occlusion (LVO) carries high morbidity despite endovascular thrombectomy (EVT).Symptomatic hemorrhagic transformation (sHT), a reperfusion-related complication, remains a critical concern. Elevated blood pressure variability (BPV) post-EVT correlates with sHT risk, but traditional BPV assessments lack real-time utility. We propose a machine learning model analyzing continuous blood pressure and heart rate to predict sHT early, enabling timely intervention and improved outcomes. Methods: We conducted a retrospective study including 615 patients with AIS who achieved successful recanalization after EVT across two hospitals. Blood pressure (BP) and heart rate (HR) measurements were recorded at 30-minute or 1-hour intervals during the first 24 hours post-EVT, and non-contrast head CT was performed to determine the presence of sHT. Patients were categorized into symptomatic HT (sHT) and non-sHT groups based on CT findings. We applied deep learning models, including LeNet and Generative Adversarial Networks (GANs), to characterize and compare BP/HR temporal patterns between groups. GAN-based augmentation was used to mitigate class imbalance by generating synthetic sHT cases, and a sliding-window strategy was implemented to support real-time prediction of sHT. Results: Using data from two hospitals, the deep learning framework identified distinct pre-sHT temporal signatures in systolic (SBP), diastolic (DBP), and HR, with SBP exhibiting the largest and most informative fluctuations prior to sHT onset. After GAN-based augmentation to address class imbalance, the model achieved strong discrimination for sHT prediction in both the training and held-out test evaluations. In the independent external validation cohort, the model correctly identified all 73 non-sHT cases and 25 of 28 sHT cases, yielding an AUC of 0.978, an accuracy of 97.0%, a specificity of 100%, and a sensitivity of 89.3%. With a 10-point sliding window, the model provided near–real-time forecasting of sHT in the next measurement interval with high accuracy. Notably, the optimal decision threshold was not identical across hospitals, consistent with inter-site differences in baseline haemodynamics, measurement frequency, and case mix. Therefore, the operating threshold was optimized separately for each hospital on the corresponding test/evaluation cohort using ROC analysis and Youden’s J statistic to balance sensitivity and specificity. In the overall test set, the model showed good generalization, achieving high accuracy in the non-sHT group and substantially improved performance for sHT following GAN-based balancing. Conclusion: Our findings show that deep learning models can anticipate symptomatic haemorrhagic transformation after EVT using early post-procedural blood pressure and heart-rate trajectories. In this framework, LeNet was used for prediction, while a GANs was applied separately to mitigate class imbalance through synthetic case generation. The resulting pipeline supports near–real-time risk estimation with high discriminative performance, offering a clinically actionable strategy for earlier identification of high-risk patients and timely intervention, with operating thresholds calibrated to the intended deployment setting.

BACKGROUND:Depressive symptoms are common in patients with subacute stroke, yet the underlying mechanisms remain unclear. We aimed to investigate the relationship between "along the perivascular space" (ALPS) indices, a measure of glymphatic dysfunction, and depressive symptoms in ischemic stroke patients, considering infarct laterality. METHODS:A prospective cohort of 104 patients with acute ischemic stroke underwent 3.0-T MRI and clinical assessments at their 3-month follow-up. The 24-item Hamilton Depression Rating Scale (HAMD) was used to assess depressive symptoms (HAMD ≥8). ALPS indices including left (L-ALPS), right (R-ALPS), infarct (I-ALPS), and non-infarct hemispheres (N-ALPS), average across L-ALPS and R-ALPS, and I-ALPS to N-ALPS ratio (I-to-N) were calculated. Logistic regression and mediation analyses were conducted to evaluate associations between ALPS indices and depressive symptoms. RESULTS:At follow-up, 32.7 % (n = 34) of patients experienced depressive symptoms. R-ALPS, but not I-ALPS or N-ALPS, was the strongest predictor of depressive symptoms (odds ratio = 0.032, 95 % confidence interval: 0.002-0.567, p = 0.019). Additionally, higher fractional anisotropy (p = 0.02) and lower fractional anisotropy (p = 0.049) in the left superior cerebellar peduncle (SCP) were correlated with depressive symptoms. Glymphatic dysfunction was directly linked to depressive symptoms, independent of left SCP metrics (p > 0.05). CONCLUSION:In subacute stroke patients, glymphatic dysfunction, particularly in the right hemisphere, is independently associated with depressive symptoms, which suggests a lateralized role in subacute mood regulation. Therefore, the ALPS index may serve as a non-invasive biomarker for stratifying patients according to risk of depressive symptoms.

The prognosis and its predictors in human immunodeficiency virus (HIV)-negative neurosyphilis remain poorly characterized. To identify clinical, laboratory, and neuroimaging predictors of poor long-term outcomes of HIV-Negative Neurosyphilis. We conducted a retrospective cohort study with prospective follow-up in 128 newly diagnosed HIV-negative neurosyphilis patients at a single tertiary center. Baseline evaluations included clinical profiles, cerebrospinal fluid (CSF) analysis, and brain magnetic resonance imaging (MRI). The primary outcome was a composite poor global outcome (modified Rankin Scale[mRS] > 2, Activities of Daily Living [ADL] > 14, or Informant Questionnaire on Cognitive Decline in the Elderly[IQCODE] > 3.19). Multivariable logistic regression identified independent predictors. After a median follow-up of 6.4 years, 40.6

BACKGROUND:The underlying functional alterations of brain structural changes among patients with empathy impairment following stroke remain unclear. We sought to investigate functional connectivity changes informed by brain structural abnormalities in multimodal magnetic resonance imaging (MRI) among patients with empathy impairment following stroke. METHODS:We enrolled people who had experienced their first ischemic stroke, along with healthy controls. We assessed empathy 3 months after stroke using the Chinese version of the Empathy Quotient (EQ). During the acute phase, all patients underwent basic magnetic resonance imaging (MRI), followed by multimodal MRI during follow-up. Our MRI analyses encompassed acute infarction segmentation, volumetric brain measurements, regional quantification of diffusion parameters, and both region-of-interest-based and seed-based functional connectivity assessments. We grouped patients based on the severity of their empathy impairment for comparative analysis. RESULTS:We included 84 patients who had stroke and 22 healthy controls. Patients had lower EQ scores than controls. Patients with low empathy had larger left cortical infarcts (odds ratio [OR] 4.082, 95% confidence interval [CI] 1.183-14.088), more pronounced atrophy in the right cingulate cortex (OR 1.248, 95% CI 1.038-1.502), and lower scores on the Montreal Cognitive Assessment (OR 0.873, 95% CI 0.74-0.947). In addition, the cingulate cortex served as the seed in the seed-based analysis, which showed heightened functional connectivity between the anterior cingulate gyrus and the right superior parietal lobule, specifically in the low-empathy group. LIMITATIONS:We did not evaluate the relationship between specific network involvement and empathy impairment among patients following stroke. CONCLUSION:Among patients with subacute ischemic stroke, reduced empathy was strongly associated with a more severe cognitive profile and atrophy of the right cingulate cortex. Our subsequent structural-informed functional MRI analysis suggests that the enhanced connectivity between the anterior cingulate gyrus and the superior parietal lobule may function as a compensatory mechanism for this atrophy.

目的 探讨非酮症性高血糖合并舞蹈症合并颅脑MRI-T1高信号综合征(C-H-BG)的临床及影像学相关因素.方法 本研究回顾性纳入17例在2010-01—2020-01诊断为C-H-BG患者为试验组;采用病例对照研究,依照纳排标准,根据试验组患者的年龄(±2岁)、性别、住院时间(±1月)按1:3匹配51例同期非C-H-BG的糖尿病患者.收集所有患者的临床及影像学资料,并进行对比,分析与C-H-BG相关的危险因素.结果 试验组中男8例,女9例,年龄(69±16.1)岁.与匹配组患者相比,C-H-BG组有更多的患者入院前无规律使用药物治疗(76.5％vs 25.3％,P=0.003),入院后首次静脉血糖更高[22.7(11.5～20)vs 11(7.7～14),P<0.001]和更高的糖化血红蛋白[(13.5±2.6)％vs(8±2.1)％,P<0.001)].在影像学因素分析方面,C-H-BG组患者更常出现基底节区异常,CT上高密度灶,T1序列高信号灶,以及SWI序列低信号灶.尽管2组患者的MCA和ICA狭窄情况无统计学差异,然而CT或MRI存在基底节异常病灶的C-H-BG患者,合并对应MCA狭窄的情况显著高于匹配组,分别为:CT-对应MCA狭窄,29.4％vs 3.9％,P=0.009;MRI/T1-对应MCA狭窄,35.3％vs 0,P<0.001,;MRI/SWI-对应MCA狭窄,35.3％vs 9.8％,P=0.013.Logistic回归方程分析发现,糖化血红蛋白为C-H-BG的预测因素,比值比(OR值)为1.787(95％可信区间:1.215～2.629),方程的拟合系数为0.724.结论 C-H-BG患者常常出现单侧/双侧基底节区病灶,表现为CT上高密度,MRI-T1序列高信号及SWI序列低信号;本研究发现CT/MRI病灶对应侧的MCA更可能同时合并狭窄;经纠正混杂因素,糖化血红蛋白为C-H-BG的危险因素.

BackgroundChanges in social behavior can occur after ischemic stroke. We aimed to investigate the potential correlations between neuroimaging variables and changes in social behavior in patients who experienced subacute ischemic stroke.MethodsWe prospectively screened patients with first-ever ischemic stroke. Three months after the index stroke, changes in patients’ social behavior were investigated by the Frontal Behavioral Inventory (FBI), which consists of both deficit and positive groups of behaviors. The protocol of brain magnetic resonance imaging (MRI) including the baseline MRI at the acute stage and additional MRI with three-dimensional T1-weighted imaging on follow-up. Using these MRI scans, we assessed the acute infarction and the volumes of various brain structures by an automatic volumetry tool.ResultsEighty patients were enrolled. In univariate analyses, patients with deficit behavioral changes had more left cortical infarction (r = 0.271, p = 0.015), Cholinergic Pathways Hyperintensities Scale scores (r = 0.227, p = 0.042), DWMH volumes (r = 0.349, p = 0.001), and modified Rankin Scale (mRS) scores (r = 0.392, p < 0.001). Patients with positive behavioral changes had more frequency of men (r = 0.229, p = 0.041) and a history of hypertension (r = 0.245, p = 0.028). In multiple stepwise linear regression models, after adjusting for age, deep WMH volumes (β = 0.849, 95% confidence interval = 0.352–1.346, p = 0.001) and mRS scores on follow-up (β = 1.821, 95% confidence interval = 0.881–2.76, p < 0.001) were significantly correlated with deficit behavioral changes (R2 = 0.245).ConclusionLarger deep WMH volumes and poorer mRS scores on follow-up were significantly correlated with deficit behavioral changes in patients with subacute ischemic stroke.

BackgroundThe non-ketotic hyperglycemic chorea (NKHC) was a rare complication for patients with diabetes mellitus, but not been well studied. In the present research, we aimed to investigate the clinical and imaging characteristics of NKHC and explore the potential association.MethodsWe performed a case-control study with patients diagnosed as NKHC. The patients with group of NKHC were retrospectively recruited, while the matched group were set to screened patients with diabetes mellitus but no NKHC at a 1:3 ratio. The clinical and imaging data were collected for all the participants of the two groups. Firstly, Correlation analysis was conducted to test the difference of all the variables between the NKHC group and matched group. Then, the putative associated factors for NKHC were further identified.ResultsEleven men and 9 women with NKHC and 60 matched participants were analyzed. The mean age of the NKHC group was 68.5 ± 14.9 years. Participants with NKHC were more likely to have a higher glycosylated hemoglobin (HbA1c) level (13 ± 2.82 vs. 10.57 ± 2.71, P<0.001), and a higher frequency of renal dysfunction (estimated glomerular filtration rates <60 ml/min/1.73m2) (55% vs. 20%, P=0.005). Logistic regression analyses showed that both higher HbA1c and renal dysfunction were significantly correlated with NKHC.ConclusionA higher value of HbA1c and renal dysfunction may be associated with the occurrence of NKHC.

The aim of the present study was to determine the neuroimaging predictors of poor participation after acute ischemic stroke. A total of 443 patients who had acute ischemic stroke were assessed. At 1-year recovery, the Reintegration to Normal Living Index was used to assess participation restriction. We also assessed the Activities of Daily Living Scale and modified Rankin Scale (mRS) score. Brain MRI measurement included acute infarcts and pre-existing abnormalities such as enlarged perivascular spaces, white matter lesions, ventricular-brain ratio, and medial temporal lobe atrophy (MTLA). The study included 324 men (73.1%) and 119 women (26.9%). In the univariate analysis, patients with poor participation after 1 year were older, more likely to be men, had higher National Institutes of Health Stroke Scale (NIHSS) score on admission, with more histories of hypertension and atrial fibrillation, larger infarct volume, more severely enlarged perivascular spaces and MTLA, and more severe periventricular hyperintensities and deep white matter hyperintensities. Patients with participation restriction also had poor activities of daily living (ADL) and mRS score. Multiple logistic regression showed that, in model 1, age, male gender, NIHSS score on admission, and ADL on follow-up were significant predictors of poor participation, accounting for 60.2% of the variance. In model 2, which included both clinical and MRI variables, male gender, NIHSS score on admission, ADL on follow-up, and MTLA were significant predictors of poor participation, accounting for 61.2% of the variance. Participation restriction was common after acute ischemic stroke despite good mRS score. Male gender, stroke severity, severity of ADL on follow-up, and MTLA may be predictors of poor participation. Trial registration number ChiCTR1800016665.

目的 研究自立支援老年照护新模式在养老机构老年痴呆患者中的应用效果.方法 选取入住东莞市东坑医院护理院的老年痴呆患者118例,采用随机对照研究,60例进入实验组,58例进入对照组.对照组应用常规照护模式,实验组应用自立支援老年照护新模式,评价第0个月(基线)、3个月、6个月时的干预效果相关指标,两组研究数据进行统计学分析,并讨论组间差异.结果 实验组的功能独立性评定(FIM)自理能力项目干预3、6个月,行走项目干预6个月得分与对照组评分具有统计学差异(P<0.05).实验组的干预3、6个月ADL评分、QOL-AD评分与对照组评分具有统计学差异(P<0.05,P<0.001).实验组的卧床率干预3、6个月与对照组具有统计学差异(P<0.001).结论 养老机构老年痴呆长者应用自立支援老年照护新模式的效果较好,可改善患者的日常生活活动能力,减少卧床,提高生活质量.

Empathy has not been well studied in patients following ischemic stroke. We aimed to evaluate the relationships of multimodal neuroimaging parameters with the impairment of empathy in patients who had experienced subacute ischemic stroke. Patients who had experienced a first-event acute ischemic stroke were recruited, and we assessed their empathy using the Chinese version of the Empathy Quotient (EQ) 3 months after the index stroke. Multimodal magnetic resonance imaging (MRI) was conducted in all the participants to identify acute infarction and assess brain volumes, white matter integrity, and other preexisting abnormalities. We quantified the brain volumes of various subcortical structures, the ventricles, and cortical lobar atrophy. The microstructural integrity of the white matter was reflected in the mean fractional anisotropy (FA) and mean diffusivity (MD), and the regional mean values of FA and MD were quantified after mapping using the ICBM_DTI_81 Atlas. Twenty-three (56.1%) men and 18 (43.9%) women (mean age: 61.73 years, range: 41–77 years) were included. The median National Institutes of Health Stroke Scale (NIHSS) score at discharge was 1 (range: 0–4). On univariate analysis, the EQ was correlated with right cortical infarction (r = −0.39, p = 0.012), putamen volume (r = 0.382, p = 0.014), right putamen volume (r = 0.338, p = 0.031), and the FA value of the right sagittal stratum. EQ did not correlated with the MD value in any region of interest or pre-existing brain abnormalities. Multiple stepwise linear regression models were used to identify factors associated with EQ. After adjusting for age and the NIHSS score on admission, the frequency of right cortical infarcts negatively correlated with EQ (standardized β = −0.358, 95% confidence interval =−0.708 to −0.076, p = 0.016), and the putamen volume positively correlated with EQ (standardized β = 0.328, 95% confidence interval =0.044 to 0.676, p = 0.027). In conclusion, in patients who have experienced subacute ischemic stroke, right cortical infarction and a smaller putamen volume are associated with the impairment of empathy.

Abstract Background Whether the circadian rhythms of blood pressure (BP) contribute to the presence of cerebral microbleeds (CMBs) remains unknown. This study aimed to assess the relationship between nocturnal BP and CMBs in hypertensive patients. Methods This prospective case‐control study recruited 51 hypertensive patients with CMBs and 51 hypertensive patients without CMBs, matched with age and gender, serving as controls. A 24‐h ambulatory BP monitoring was conducted in all subjects. Differences in ambulatory BP parameters between the two groups were compared. Logistic regression analyzes were conducted to investigate the relationship between the ambulatory BP parameters and presence of CMBs. Results Patients with CMBs had a significant higher nocturnal mean SBP and lower relative nocturnal SBP dipping rate. Two logistic models were constructed to explore the association between ABPM indices and the presence of CMBs, adjusted with history of ischemic stroke and smoking. In model 1, higher nocturnal mean SBP positively correlated with presence of CMBs [standardized β = 0.254, odds ratio (OR) = 1.029, p = .041]. In model 2, the relative nocturnal SBP dipping rate was negatively correlated with CMBs (standardized β = −.363, OR = 0.918, p = .007). Only patients with deep CMBs had significant higher nocturnal mean SBP and lower relative nocturnal SBP dipping rate in comparison with those without CMBs. Conclusions Higher nocturnal SBP and lower relative nocturnal SBP dipping rate may be associated with CMBs in hypertensive patients.

家族性淀粉样多发神经病(familial amyloid polyneuropathy,FAP)是一种由淀粉样蛋白质在神经系统及其它系统中沉积导致临床症状的常染色体显性遗传病.根据淀粉样蛋白的前体蛋白类型,FAP分为甲状腺素转运蛋白相关FAP(transthyretin-familial amyloid polyneuropathy,TTR-FAP)、载脂蛋白A-1相关FAP和凝溶胶蛋白相关FAP,其中TTR-FAP最为常见[1].TTR-FAP是由于突变的TTR(mutated familial amyloid polyneuropathy,mTTR)沉积在周围神经而致病,通常引起神经长度依赖性多发性神经病[1,2,常见临床表现包括早期的感觉运动性周围神经病(手套-袜套样感觉减退、肢体肌力下降)、自主神经功能障碍(直立性低血压、恶心、腹泻、性功能障碍等)[3.载脂蛋白A-1型FAP的特征是淀粉样蛋白沉积在包括肾脏、肝脏和心脏等主要器官,最终导致器官功能衰竭.凝溶胶蛋白型FAP的病程缓慢且相对良性,其临床特征是颅骨异常、周围感觉神经病、角膜营养不良和皮肤松弛.[1]本文报道1例以性功能障碍为首发症状的FAP并进行文献回顾.

目的 探讨缺血性脑卒中患者脑皮层胆碱能通路(cortical cholinergic pathways,CCP)受损的临床及影像学相关因素.方法 纳入473例起病7 d内的急性缺血性脑卒中患者,收集患者的临床资料及影像学资料.CCP的损害程度采用胆碱能通路高信号量表(cholinergic pathways hyperintensities scale,CHIPS)进行评估.采用相关分析筛选与CHIPS评分相关的临床及颅脑MRI变量,并应用线性回归方程探讨CCP的相关危险因素.结果 本组患者年龄(60.31±14.19)岁,男334例(70.6％),CHIPS评分(17.31±17.72)分.相关分析显示,CHIPS评分与年龄(r=0.356,P<0.001)、男性(r=0.131,P=0.004)、高血压史(r=0.188,P<0.001)、心房纤颤病史(r=0.109,P=0.018)、既往卒中史(r=0.201,P<0.001)、入院时NIHSS评分(r=0.159,P=0.001)以及脑梗死病因分型(r=0.092,P=045)相关.同时,CHIPS评分与双侧皮层下区域的脑梗死(左侧:r=0.113,P=0.014;右侧:r=0.098,P=0.033)、脑干梗死(r=—0.116,P=0.012)、脑梗死体积(r=0.131,P=0.004)、侧脑室旁白质病变(r=0.652,P<0.001)、深部脑白质病变(r=0.67,P<0.001)和内侧颞叶萎缩(r=0.545,P<0.001)相关.建立线性回归模型,采用共线性分析排除存在共线性的变量,结果显示,CHIPS评分与入院时NIHSS评分及深部脑白质病变相关,方程的校正决定系数为0.513.结论 缺血性脑卒中患者常合并CCP损害,较严重的CCP损害可能与更严重的脑梗死及深部脑白质病变相关.

目的 探讨英文文献阅读在神经内科住院医师规范化培训中的应用效果.方法 纳入2018年1月至2019年12月在东莞市人民医院神经内科轮转的48名住培生为教学对象,随机分为试验组和传统教学组,轮转时间均为3个月.传统教学组按照教学大纲和培养目标进行传统临床教学,包括教学查房、小讲课和病例讨论、操作指导等环节,根据临床教学内容自行阅读相关文献;试验组在传统临床教学基础上,每4周参加1次英文文献阅读报告会,共3次.出科时两组均参加闭卷理论考试和技能操作考核,并填写教学满意度调查表.比较试验组3次英文文献阅读报告评分,同时比较两组出科考核成绩、教学满意度.结果 试验组出科考核成绩和教学满意度高于对照组,差异有统计学意义;试验组3次英文文献阅读报告评分呈逐次升高趋势.结论 在神经内科住院医师规范化培训中开展英文文献阅读,能提高住培生的临床实践能力和科研能力,促进自主学习,值得推广.

Purpose: Impairment of cortical cholinergic pathways (CCP) is an important risk factor for chronic vascular cognitive impairment. However, this phenomenon has rarely been studied in post-stroke cognitive impairment (PSCI). We investigated the relationship between PSCI and CCP lesions assessed by structural magnetic resonance imaging (MRI).Patients and methods: We prospectively enrolled 103 patients within 7 days of ischemic stroke onset. CCP was measured by the cholinergic pathways hyperintensities scale (CHIPS), which semiquantitatively grades MR lesions strategically located on the CCP identified in human brains. We also measured other MRI parameters, including the location and volumes of acute infarcts, cerebral microbleeds, medial temporal lobe atrophy, and white matter lesions. Neuropsychological assessments were performed using the 60-min modified vascular dementia battery (VDB) at 3 months after the index stroke, and PSCI was defined according to VDB as well as ADL.Results: Of all 103 patients, 69 men (67.0%) and 34 women (33.0%) with a mean age of 57.22 ± 12.95 years, 55 patients (53.4%) were judged to have PSCI at 3 months, including 43 (41.7%) patients with PSCI-no dementia and 12 (11.7%) patients with poststroke dementia. According to the VBD assessment, the most commonly impaired cognitive domain was visuomotor speed (27.2%) followed by verbal memory (25.2%). Univariate analysis showed that patients with PSCI were older; had higher informant questionnaire on cognitive decline in the elderly (IQCODE) scores; had more frequent previous stroke history and atrial fibrillation; and had higher CHIPS scores, more severe white matter lesions, and medial temporal lobe atrophy. PSCI patients also had higher depression scores at 3 months. In the multivariate regression analysis, age, IQCODE score, CHIPS score, and Hamilton depression rating scale score were independent predictors of PSCI. Ordinal regression analysis for risk factors of poor functional outcomes revealed that IQCODE scores and cognitive function status were related to mRS score at 3 months after stroke.Conclusion: In patients with early subacute ischemic stroke, the severity of lesions involving the CCP may be associated with cognitive impairment at 3 months.Clinical Trial Registration: Chinese Clinical Trial Registry, identifier: ChiCTR1800014982.

Background: Whether autonomic dysfunction contributes to cerebral small vessel disease (CSVD) remains unclear. This study aimed to explore the relationship between CSVD and blood pressure variability (BPV) and heart rate variability (HRV). Methods: This case-control study recruited 50 patients with CSVD and 50 non-CSVD hypertensive age- and gender-matched controls. All participants completed a 24-h ambulatory electrocardiogram recording and ambulatory BP monitoring (ABPM). Differences in HRV and BPV between the two groups were examined. BPV indices assessed by ABPM included mean systolic BP (SBP), mean diastolic BP (DBP), coefficient of variation and weighted standard deviation of SBP and DBP. Results: CSVD patients had significant higher 24-h mean systolic BP (SBP), 24-h mean diastolic BP (DBP), daytime mean SBP, nocturnal mean SBP, and nocturnal mean DBP (P < .05 for all). CSVD patients had a significant lower nocturnal SBP fall rate compared with controls (median: 1.0 versus 6.2, respectively; P < .001) and were more likely to be non-dippers and reverse dippers. There were no differences in HRV variables between the two groups. Five logistic models were built to explore the correlations between BPV indices and CSVD. BPV indices were separately entered into the logistic regression models, together with hyperlipidemia, ischemic stroke history, current use of anti-hypertensive agents, and serum blood urea nitrogen. In models 1-3, 24-h mean SBP and nocturnal mean SBP and DBP were significantly correlated with CSVD (r(2) = 0.308-0.340). In model 4, the nocturnal SBP fall rate was negatively correlated with CSVD (odds ratio [OR] = 0.871, 95% confidence interval [CI] = 0.804-0.943; P = .001), with r(2) = 0.415 fitting the model. In model 5, the pattern of SBP dipping was significantly associated with CSVD, with non-dipper (OR = 8.389, 95%CI = 1.489-47.254; P = .016) and reverse dipper (OR = 27.008, 95%CI = 3.709-196.660; P = .001) having the highest risks of CSVD (r(2) = 0.413). Conclusions: Lower nocturnal SBP fall rate is associated with CSVD. Non-dipper and reverse dipper hypertensive patients have a higher risk of CSVD.

Abstract Background Susceptibility weighted imaging (SWI) provides an approximate assessment of tissue perfusion and shows prominent hypointense cortical veins in the ischemic territory because of the increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO). Methods One hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as an increase in the National Institutes of Health Stroke Scale score ≧2 points despite standard treatment in the first 72 h after admission. The APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI. Results Thirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P = 0.001). Patients with APCVS were more likely to have END (40.0%, vs. 12.2%, P = 0.001) than those without END. Multivariate logistic regression indicated that APCVS (OR = 4.349, 95% C.I. = 1.580–11.970, P = 0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume. Conclusions In acute ischemic stroke patients with SIASO, the APCVS might be a useful neuroimaging marker for predicting END, which suggests the importance of evaluation of perfusion status.

Background. The relationship between the neutrophil-to-lymphocyte ratio (NLR) and hemorrhagic transformation (HT) in acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) remains unclear. This study assessed whether high NLR is associated with HT in this population. Methods. Data were prospectively collected for continuous patients with AIS treated with IVT and retrospectively analyzed. Clinical variables included age, sex, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, onset-to-treatment time, and initial hematologic and neuroimaging findings. HT was confirmed by imaging performed within 3 days after IVT. Symptomatic HT (sHT) was defined as NIHSS score increased by 4 points compared with that on admission according to previously published criteria. The NLR value was based on the blood examination before IVT, and high NLR was defined as ≥75th percentile. Results. The study included 285 patients (201 (70.5%) males, the mean age was 62.3 years (range 29–89)). Seventy-two (25.3%) patients presented with HT, including three (1.1%) with sHT. The median NLR was 2.700 (1.820–4.255, interquartile range). Seventy-one (24.9%) patients had a high NLR (≥4.255) on admission. Univariate analysis indicated that patients with HT had higher NIHSS scores (P<0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P<0.05), as well as a greater prevalence of high NLR than those without HT (37.5% vs. 20.7% and P=0.004). Patients with HT were more likely to have hypertension and AF. As lymphocyte counts and high NLR were highly correlated, we used two logistic regression models. In model 1 (with high NLR), NIHSS score on admission (odds ratio (OR) = 1.110, 95% confidence interval (CI) = 1.015–1.044, and P=0.001), AF (OR = 3.986, 95% CI = 2.095–7.585, and P<0.001), and high NLR (OR = 2.078, 95% CI = 1.078–4.003, P=0.029, sensitivity 0.375, and specificity 0.793) were significant predictors of HT. In model 2 (with lymphocyte counts), NIHSS score on admission (OR = 1.111, 95% CI = 1.050–1.175, and P<0.001), AF (OR = 3.853, 95% CI = 2.048–7.248, and P<0.001), and lymphocyte counts (OR = 0.522, 95% CI = 0.333–0.819, and P=0.005) were significantly associated with HT. Conclusions. High NLR could be a useful marker for predicting HT in AIS patients after IVT.

Objective The aim of this prospective cohort study was to determine the incidence and neuroimaging risk factors associated with Babinski sign following acute ischemic stroke, as well as its relationship with the functional outcome of patients. Methods A total of 351 patients were enrolled in the study within 7 days of acute ischemic stroke. The Babinski sign along with other upper motor neuron signs were examined upon admission and between days 1 and 3 and days 5 and 7 after admission. Neuroimaging parameters included site and volume of infarction and white matter lesions. All patients were followed up at 3 months. Functional outcome was assessed with the Lawton Activities of Daily Living scale and modified Rankin Scale. Results Babinski sign was observed in 115 of 351 (32.8%) patients in the acute ischemic stroke. These patients had higher National Institutes of Health Stroke Scale (NIHSS) scores at admission and higher rates of atrial fibrillation and cardioembolism; higher frequencies of frontal, temporal, and limbic lobes and basal ganglia infarcts; and larger infarct volume. Higher NIHSS score and basal ganglia infarct were significant predictors of the presence of Babinski sign. After adjusting for confounds, the presence of Babinski sign did not predict poor functional outcome. Conclusion The incidence of Babinski sign was 32.8% in the acute ischemic stroke. Severe infarction and basal ganglia infarct were independent predictors of Babinski sign. Although Babinski sign is common in acute ischemic stroke patients, it does not predict poor functional outcome 3 months later.